Episode 20 - Choosing A Qualified Doctor For Your Cosmetic Surgery with Christopher Saunders, M.D.

Do you know who has the scalpel above your face? Choosing a qualified Dr. for your cosmetic surgery.

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Teri Hausman: I’m Teri Hausman host of Beauty Now. Beauty Now brings you the latest in anti-aging, cosmetic surgery, mini and extreme makeovers. Today we have Dr. Christopher Saunders who wrote the book, “A Woman’s Guide to the Real Reality of Cosmetic Surgery.”

Chris: Saunders: Yes, many of the shows can actually show surgery that might be extensive, too-much and in many situations, dangerous and the person watching, if they are not a doctor, wouldn’t know that what they’re seeing should not be done that way. So it’s just skewed, it’s TV, just like all other televisions shows. They’re meant to entertain, not to be educative. So the key is you have to be educated as a consumer. There are 24 board certifications…you can get this on the internet, you can go to the American Board of Medical Specialties, and check on your family doctor and check on your pediatrician and all your other doctors. But there is one for plastic surgery.

There is no such thing for cosmetic surgery. It just does not exist. There are no plastic surgery journals and stuff like that. They will have courses called Liposuction 101 or Face-lift 101, and what they will say is, “Take a weekend course in liposuction and learn how to do liposuction and be certified.” You pay a couple thousand dollars, you might be a gynecologist, and you now might be ready to do liposuction in your office. That’s scary.

You wouldn’t go to the plastic surgeon for a brain operation, brain surgery and so you probably wouldn’t want to go to the facial plastic surgeon for liposuction for stomach or for breast enlargement. It’s not part of the training.

Terri: Welcome, Dr. Saunders.

Chris: Hi, how are you?

Terri: Great. Thanks for agreeing to be with us today. We have so many questions for you.

Chris: Thank you so much.

Terri: First of all, your book, I think lets women know how to choose a plastic or reconstructive surgeon.

Chris: Yes, that’s correct.

Terri: So what questions would a patient, let’s just say I was going to go in for a consultation, what would I ask my doctor?

Chris: Well, let me, if you don’t mind, give a little introduction on what the book stresses and covers. Then I can answer these questions.

Terri: That would be great.

Chris: It covers and I think it will help answer these questions.

Terri: That would be great. Tell our listeners what it’s all about.

Chris: O.k. Well, the reason it’s called, ”A Woman’s Guide to the Real Reality of Cosmetic Surgery” is because in this day and age with all the television shows, they’re called reality TV, we have Extreme Makeover, I Want a Famous Face, Dr. 90210. The information that the consumer that sees these shows comes away with is not reality.

For example, with reality TV, when were you last on a desert island vying for a million dollars; like Survivor? These are not reality. So people come away from watching these TV shows or reading People Magazine or other internet sites, they come away with information that could be skewed or could be misinformation.

So the book tries to educate in a very easy to read, informative, a very clear manner to educate the person on realistic expectations from surgery, cosmetic surgery, and realistic recovery from cosmetic surgery and realistic results that I call the real reality.
Terri: Well I think that’ s refreshing because I do think there are so many women out there that are misinformed and they watch something, like one of these reality shows and they’re like, “Wow! Is that the way it is?” And it’s not at all.

Chris: Yes, many of the shows actually can show surgery that might be extensive, too much and in many situations, dangerous. The person watching, if they’re not a doctor, wouldn’t know that what they’re seeing should not be done that way. So it’s a skewed. It’s TV, just like all other television shows, they are meant to entertain, not to be educated and if you are considering having cosmetic surgery and having the real operation you need to be informed so you can be happier and have a better result.

Terri: I do agree. I do have one example for our listeners. I had a girlfriend called me and say that, a surgeon in Orange County, did not believe in Endoscopic brow lifts. And I just told her, “Well does he do them and is he trained for them?” My question to you is, “How do people that don’t train in surgery advertise as board certified cosmetic surgeons and how do you know their credentials?”

Chris: Well, that is a very, very good question. And there’s a chapter in the book on this. And so I’m going to discuss it right now. Doctor’s like pediatricians, family doctors, anesthesiologists; they’re board certified by something called the American Board. So they would be the American Board of Pediatrics, the American Board of Anesthesia, and there is a governing board called the American Board of Medical Specialties.

So this governing board recognizes 24 Board certifications that the average person thinks of as board certified. So your family doctor, your OBGYN doctor which is your gynecologist, your general surgeon, your, as I said your pediatrician. There is also one in plastic surgery.

So plastic surgeons can be board certified by the American Board of Plastic Surgery. It’s one of 24 exclusive boards. When people talk about board certification, this is what they’re talking about.

Terri: And to clarify, we want somebody who specialized or went to school, to be a plastic or cosmetic surgeon. Correct?

Chris: Well, here’s the situation: So there is no board certification in cosmetic surgery that you and I recognize. Because there are only 24 boards recognized by the American Board of Medical Specialties. However, people don’t have a monopoly on board certification. So what’s happened is in the past some doctors have actually created boards.
You and I could start a board tomorrow and call it the board certification of young cosmetologists. And no one could stop us and we could say we were board certified. Who could we say certified us? Young cosmetologists. There’s no such thing. And it can be misleading. So the key is you have to be educated as a consumer.

There are 24 board certifications. You can get this on the internet. You can go to the American Board of Medical Specialties and check on your family doctor, and check on all your pediatricians and check on all your family doctors. There is one for plastic surgery. There is no such thing for cosmetic surgery. It just does not exist.

Terri: Good to know. And that board is called, “The American Board…?”

Chris: The American Board of Plastic Surgery. So when you are looking for a cosmetic surgeon, in my opinion, you need to find a doctor who is board certified by the American Board of Plastic Surgery. Because Plastic surgery is especially, where we are trained extensively, the training for plastic surgeons, mine, was 8 years long, that doesn’t even count medical school. If you count medical school it was 12 years.

Cosmetic surgery is a huge focus. And a plastic surgeon is an expert in the field of cosmetic surgery. So when I call myself a cosmetic surgeon, it’s because I focus on cosmetic surgery. But I’m not board certified in cosmetic surgery because there is no real board in that.
So the key to summarize, because what I said, could be looked upon as confusing, the key is your want to look for a board certified plastic surgeon to know that your doctor has had excellent training, and has done the requisite operations so he is ready to do the forehead or endoscopic operation you talked about.

Terri: That he was trained to do.

Chris: Because there are actually doctors of dentistry who advertise cosmetic surgery. It’s scary.

Terri: Right. We’ve seen it everywhere now.

Chris: It’s scary, in my opinion, you have in the community, where I’m from the East Coast, and we have a community, where a gynecologist advertises as a cosmetic surgeon.

Terri: They are doing liposuction? Which is scary. Even though they might be great in their profession that they trained in.

Chris: That’s exactly right.

Terri: So can these doctors do surgery in a hospital or in surgery centers if they have limited, if any surgical training for cosmetic procedures?

Chris: Well it’s tough for them to get hospital privileges in many states because the hospitals will check the credentialing. Surgicenters and office space facilities are much easier. Understand it’s not illegal for them to do it. And ironically there are some doctors who, I have seen, who, let’s say an ophthalmologist that specializes in facial cosmetic surgery. And some of them can actually be very good doctors and provide very good care. But on average you have to be careful because they don’t have the requisite training to do these operations and they are learning them through less conventional methods.
Did you know there are actually courses you can take, like if I open one of my doctor magazines, these are not magazines that, you buy at a bookstore. These are magazines that are subscription, like the Plastic Surgery Journals and stuff like that. They will have courses called Liposuction 101 or Facelift 101 and they will say, “Take a weekend course in liposuction and learn how to do liposuction and be certified.” And so you pay a couple thousand dollars, you might be a gynecologist and now you are ready to do liposuction in your office. It’s scary.

Terri: That is scary, and it’s as the wife of a plastic surgeon I know there are often courses of trendy things as well. So doctors would like to be up on the trendy things. And can you warn the women the dangers of the trendy things such as the thread lift?

Chris: I think that you’re bringing up another good point. What happens is medicine and plastic cosmetic surgery, slowly progress so new inventions do happen but they don’t happen on a daily basis, like People Magazine or US Magazine wants us to believe. So every single day, you pick up a new source and you see, “Here’s a new way to do a facelift.”

I call it the instantaneous facelift. There is no such thing. But there are doctors that have trademarked facelifts with different descriptions. One is not called the instaneous facelift…but…

Terri: Wishful thinking.

Chris: Wishful thinking, because if you have an operation on your face, you’re going to have to have bruising and swelling which resolve. That takes a couple weeks typically.

Terri: And pretty much there is not a miracle out there. And pretty much you have to get a consultation to see what you need.

But all your saying is how does the average person find out the credentials of their doctor? Let’s just say I want to come in to you and say I want a procedure done. How can I look you up or what questions should I ask you?

Chris: Well, most doctors now, they have a website, so you could go to their website and look for their credentials. The office manager would also provide the person with a resume or curriculum vitae which is the doctor term for a resume. And you can look up, where they went to school, or what their board certification is in. I don’t think anybody should see a doctor that’s not board certified anymore in any specialty.

So you’re looking for the American Board of Specialty that you’re seeking, in this situation we’re talking about Plastic Surgery. You can then look at where they trained, did they do any fellowships? Have they done any publications? So you can get into more details about the level of their training. It’s also good to see what societies they belong to. Are they a member of the American Medical Association? Are they a member of the American Society of Plastic Surgery? This is another society.
Now societies are not something you get from going to school. You have to be board certified or eligible to even be a member but they check continuing education of the plastic surgeon and also, which is very interesting, ethics. So plastic surgeons, if they are board certified and member of the plastic surgery society cannot be involved in false advertising or they can lose their credentials.

Chris: That is such a good point. We need to take a break to thank our Beauty Now sponsors. And we’ll be right back.

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Terri: Hi. We’re back, talking with Dr. Christopher Saunders, all about if your doctor is qualified to operate on you. Hi again.

Chris: Hi.

Terri: When we left off, we were talking about board certification and society. My next question to you is, “What about if you are going in for a breast augmentation and your doctor is an ear nose and throat specialist, specializing in facial surgery. What should I as a patient do?

Chris: Well, I, as a patient, would talk to the doctor and ask them if you specialize in facial plastic surgery, what does breast surgery have to do with that particular location of the body? In my community, most facial plastic surgeons do not do surgery off of the face. But I am aware that in other states where competition is more competitive it drives these people to do operations on other parts of the body.

They might take some basic courses that I described in the first segment or the liposuction courses and start doing body contouring or breast enlargement.

I would be very careful about choosing a doctor that does that. I think that would be unwise. Most of the doctors don’t’ do it. So if you are picking a doctor that’s an exception, maybe he should be best in the world, as that would be an exception. But don’t pick someone that’s not working within the capacity of their basic training. I would recommend someone else.

Terri: Now facial plastic surgeons, are they more qualified to do rhinoplasty? Is that something you may consider rather than body surgery?

Chris: I wouldn’t say they were more qualified to do it. A facial plastic surgeon classically is a board certified ENT Doctor, or a board certified otolaryngologist and part of their training is nose surgery.
Like the plastic surgeon, the nose is part of the plastic surgeons training. It’s part of an ENT doctor’s training. So a rhinoplasty would be part of either specialty and it would be wrong of me to say they couldn’t do a good job because they can and so can the plastic surgeon. You pick the one that’s best. You wouldn’t go to the Plastic Surgeon for brain surgery so you probably wouldn’t want to go to the facial plastic surgeon for liposuction of the stomach or for breast enlargement. It’s just not part of the training.

Terri: What about women with Body Dysmorphic, we recently cam e across a twenty eight year old that has had 7 nose jobs , a face list, brow lift and redid everything. How do you know you’re doctor’s going to say no to these people? What about Michael Jackson? I hate to say that, but he’s a good example. Do you turn people away?

Chris: You want a doctor that sits down with you during a consultation. He listens to what you have to say and then he educates you on your option. So it should be kind of, in my opinion, it should be like listening to a college lecture. So you’re learning about breast enlargement or nose jobs. And it’s not being pushed on you. And it’s not being sold to you. You hear what he has to say. You learn about it. He discusses it. You would throw in questions that you have. And then you make your decision in an educated fashion whether you should proceed with surgery.

People with Body Dysmorphic Syndrome, the doctors that might not recognize they have a problem, operate on these patients and don’t do the patients any good. And someone like Michael Jackson that may or may not have the problem, he wants an appearance to his nose that clearly is not what the normal person would want.

Terri: Right and I’ m not saying that he does have the problem it just appears that he does.

Chris: That’s correct. The good news is about this Body Dysmorphic Syndrome is actually more of a risk to the patient with the problem and the doctor doing the surgery. Not to the average person that wants plastic surgery.

Terri: Right, but if you see somebody in their 20s coming in for a face lift and procedure after procedure, wouldn’t that be a good doctor to say you really need a psychiatrist instead of a plastic surgeon?

Chris: Yes, you really would, if you had someone like that, if that doctor’s making bad decisions on other patients, then maybe he might not be the best doctor for me.

Terri: Let’s change the topic. What’s your favorite plastic surgery?

Chris: I specialize in facial rejuvenation and breast and body sculpting. Now facial rejuvenation is a very broad topic and I think with the new hot trend of noninvasive procedures and you brought up thread lifts what I call puppet string lifts, we don’t have to use any trademark names, but puppet string lifts. So the latest trend right now is non-cutting and non-selling/stiches. People who want to look and feel better, younger, without stitches and I think they’re fantastic.

But the most important thing to understand about these procedures is they only help us to a degree. They won’t get rid of bags around the eyes. They are not going to get rid of jowls or big folds in the neck or a turkey gobble. Noninvasive procedures such as filler to help with the folds around the mouth or wrinkles around the lips help us. They improve the situation. They don’t get rid of the problem.

Terri: So what’s your favorite filler?

Chris: I personally use a multitude of fillers. If you came in and asked me that I would give you a more long winded answer. my answer would be the fillers are like ice cream in an ice cream shop; vanilla, strawberry, chocolate, rocky road. I would describe the pros and cons. The most popular filler in my office and around the country are hyaluronic acid. Juvéderm™ and Restylane® are the most popular brands. There are longer acting products such as Radiesse®, and Sculptra®, which have additional benefits. There is no, unfortunately, perfect filler that lasts forever.

Terri: So what filler would you use around the eyes?

Chris: Around the eyes, because the skin is so thin, 12 microns thin, you have to be very careful and I recommend sticking with the hyaluronic acid. You wouldn’t want to go with a thicker or more permanent product. You wouldn’t want to go with a thicker product as you would have a greater chance of lumpy application.

Terri: How long does hyaluronic acid last?

Chris: Classically, the companies say it takes 6 months to a year and sometimes they’ll advertise a year or longer. But for the average patient is 4-6 months. I usually circle 6 months and think 6 months is very reasonable.

Terri: Talk about Radiesse® for a second. I think that it’s so confusing with all the new fillers out.

Chris: Radiesse®, is a calcium based product. And it’s one I tell people, like ground up bone, not bone from a dead person, but you can think of it as bone is a calcium product. It looks like toothpaste. It is white. It lasts up to 18 months, which is hopefully 3 times longer than hyaluronic acid. It can only be used on some areas on the face.

It’s not good unfortunately for the lips, because there has been a 5% or a 10 instance, that’s 1 in Twenty approximately will get a cyst on the lip. That’s something we don’t’ want. So usually you don’t use it for a lip enlargement or wrinkles on the lips. Usually you use it for around the mouth which is the nasal labial fold. I think that’s the most common location to use Radiesse®.

Terri: And that’s from your nose to your lips?

Chris: Exactly.

Terri: And what’s your favorite filler for lips? Lips are a huge thing for women. They love their lips but what are the best things to do?

Chris: Well, I would review the options with them as I already said. For example, if women are having liposuction then I am a huge fan of using her own filler, which is fat. I do fat transfer which involves centrifugation and purification of the fat and through micro droplet application These were techniques popularized by a Dr. __ [?] in New York City and fat is fantastic for the lips.

But that is typically more expensive than something you would just grab off the shelf in the office. So if someone is having liposuction it’s a filler I recommend. I say, “Hey, let’s use your own fat.”

Terri: That’ such an appealing thing. [laughs] What about women that aren’t having liposuction. Can you get some fat off them?

Chris: If they’re not, I typically recommend Juvéderm™ , Restylane , and hyaluronic acid.

Terri: And how long does the fat transfer last?

Chris: Well that’s a great question. A lot of people come in and say I heard fat is permanent. And that’s probably oversimplification. There’s permanence associated with it. Fat unfortunately, it’s your own product that’s been processed and reinjected. It can last from 3 months to multiple years. That is a huge range of time. It can be very disappointing.

It’s not uncommon to have someone come in who got a fat transfer from another doctor and thought it was permanent and 3 months later it’s gone. That’s bad luck. It usually lasts longer than that but that’s the main risk of fat transfers is that it can go away very quickly. Most people get longer periods of time out of it. The range is months to years. There is one good study that after one year, biopsies showed fifty percent of it was still there.

Terri: And do you transfer fat anywhere else?

Chris: I also use it on the nasal labial fold and also for the cheeks. As we age one of the latest concepts in aging, if I someone grabs their face and pulls on their jowls or neck they feel if they feel the tissue has descended. Almost like a breast that’s hanging. The tissue is hung. It’s dropping. Well, one of the hottest spots right now is facial descent; also the loss of fat in key areas.

So the best rejuvenation can be not just lifting the skin but reinjecting or treating the loss of fat. So that’s where fat transfer comes in. The lifting techniques tend to lift the skin, to position the tissue to where it was when you were younger and the fat was reinjected to where we have lost fat.

Terri: Well Dr. Saunders, I think you have just inspired a lot of men and women to come in and grab their jowls and get a consultation. Unfortunately, we are out of time. We are going to have to have you back. It’s been so interesting and I think really informing for men and women to check out their doctors. So check out Dr. Christopher Saunder’s book, “A Woman’s Guide to the Real Reality of Cosmetic Surgery.”You can also go to our website at personallifemedia.com, beauty now, and click on, and we’re going to link Dr. Saunders’ website to ours so you can check out all the procedures and get a consultation with him. Thanks again for being with us today and I’m sorry that we’re out of time. We’re going to have you back.

Chris: Thank you very much. Have a nice day.

Terri: You have a great day too.

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